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I
A SPECIAL REPORT SERIES BY THE N.C. DEPARTMENT OF HUMAN RESOURCES, DIVISION OF
HEALTH SERVICES, STATE CENTER FOR HEALTH STATISTICS, P.O. BOX 2091, RALEIGH, N.C. 27602
No. 41 July, 1986
ALCOHOL-RELATED MORBIDITY AND MORTALITY
hOS VB 1986
IN NORTH CAROLINA
N.C. STATE LIBRARY
RALEIGH
by
Paul A. Buescher
and
Michael J. Patetta
INTRODUCTION
Social and economic development and the advent of
scientific medicine in the twentieth century have resulted
in great progress in the conquest of infectious diseases.
Reflecting increased affluence, alterations in life style, and
other developmental changes, the addictive use of tobacco,
alcohol, and other substances has made drug abuse the
leading cause of death in the United States. "This striking
fact, however, has been obscured in the nation's vital
records and statistics by the general practice of certifying
and coding addictive disease deaths according to their
numerous anatomic and disease manifestations, while fail-ing
to note the addictive practices underlying such preco-cious
deaths" (1). Ravenholt estimates that nearly one-third
of all deaths in the United States in 1980 were
attributable to the abuse of addictive substances: about 25
percent from tobacco, 5 percent from alcohol, and 2
percent from other substances (1). Another source esti-mates
that as much as 10 percent of all deaths in the
United States are alcohol-related (2).
At prejent it is not possible to accurately quantify the
impact on mortality of the smoking of tobacco. Diagnoses
indicating tobacco dependence as a contributing cause of
death are extremely under-reported on death certificates,
with only three percent of 1985 North Carolina lung
cancer deaths and less than one percent of total deaths
having the ICD-9 diagnosis code 305.1 recorded. Should
information from a revised death certificate with a smok-ing
check-box or from some other source become availa-ble,
this relationship would certainly warrant further
investigation. We are fortunate, however, to have several
sources of data that can be used to document the health
effects of alcohol use. Primary among these is the Medical
Examiner data system, which contains information for
approximately 15 percent of all deaths in North Carolina
each year, including all accidental and violent deaths.
Results from blood alcohol tests are included for around
80 percent of these deaths investigated by the Medical
Examiner. Thus a major section of this report will look at
alcohol-related mortality using this data source.
The method of this study is descriptive, using data from
a variety of secondary sources. After a review of data on
alcohol-related morbidity in North Carolina, the question
of alcohol-related mortality is considered. Finally a dis-cussion
of the results is presented.
ALCOHOL-RELATED MORBIDITY
"Life used to be simpler when we believed that all
alcohol consumption was bad. Our upbringing indicated
that increased consumption was not only detrimental to
health but was linked to weak moral character" (3). In
fact, recent evidence indicates that moderate alcohol con-sumption
may be related to health benefits, particularly in
terms of reducing susceptibility to coronary heart disease
(3,4), and perhaps more generally as an occasional buffer
against the harsher vicissitudes of life. In this regard,
alcohol consumption is different from tobacco use, where
there is no safe lower threshold ( 1 ). Of course, many
people do not succeed in containing their alcohol con-sumption
within safe limits, and the negative health con-sequences
of excessive alcohol consumption, with which
this report is concerned, are serious and widespread.

I
A SPECIAL REPORT SERIES BY THE N.C. DEPARTMENT OF HUMAN RESOURCES, DIVISION OF
HEALTH SERVICES, STATE CENTER FOR HEALTH STATISTICS, P.O. BOX 2091, RALEIGH, N.C. 27602
No. 41 July, 1986
ALCOHOL-RELATED MORBIDITY AND MORTALITY
hOS VB 1986
IN NORTH CAROLINA
N.C. STATE LIBRARY
RALEIGH
by
Paul A. Buescher
and
Michael J. Patetta
INTRODUCTION
Social and economic development and the advent of
scientific medicine in the twentieth century have resulted
in great progress in the conquest of infectious diseases.
Reflecting increased affluence, alterations in life style, and
other developmental changes, the addictive use of tobacco,
alcohol, and other substances has made drug abuse the
leading cause of death in the United States. "This striking
fact, however, has been obscured in the nation's vital
records and statistics by the general practice of certifying
and coding addictive disease deaths according to their
numerous anatomic and disease manifestations, while fail-ing
to note the addictive practices underlying such preco-cious
deaths" (1). Ravenholt estimates that nearly one-third
of all deaths in the United States in 1980 were
attributable to the abuse of addictive substances: about 25
percent from tobacco, 5 percent from alcohol, and 2
percent from other substances (1). Another source esti-mates
that as much as 10 percent of all deaths in the
United States are alcohol-related (2).
At prejent it is not possible to accurately quantify the
impact on mortality of the smoking of tobacco. Diagnoses
indicating tobacco dependence as a contributing cause of
death are extremely under-reported on death certificates,
with only three percent of 1985 North Carolina lung
cancer deaths and less than one percent of total deaths
having the ICD-9 diagnosis code 305.1 recorded. Should
information from a revised death certificate with a smok-ing
check-box or from some other source become availa-ble,
this relationship would certainly warrant further
investigation. We are fortunate, however, to have several
sources of data that can be used to document the health
effects of alcohol use. Primary among these is the Medical
Examiner data system, which contains information for
approximately 15 percent of all deaths in North Carolina
each year, including all accidental and violent deaths.
Results from blood alcohol tests are included for around
80 percent of these deaths investigated by the Medical
Examiner. Thus a major section of this report will look at
alcohol-related mortality using this data source.
The method of this study is descriptive, using data from
a variety of secondary sources. After a review of data on
alcohol-related morbidity in North Carolina, the question
of alcohol-related mortality is considered. Finally a dis-cussion
of the results is presented.
ALCOHOL-RELATED MORBIDITY
"Life used to be simpler when we believed that all
alcohol consumption was bad. Our upbringing indicated
that increased consumption was not only detrimental to
health but was linked to weak moral character" (3). In
fact, recent evidence indicates that moderate alcohol con-sumption
may be related to health benefits, particularly in
terms of reducing susceptibility to coronary heart disease
(3,4), and perhaps more generally as an occasional buffer
against the harsher vicissitudes of life. In this regard,
alcohol consumption is different from tobacco use, where
there is no safe lower threshold ( 1 ). Of course, many
people do not succeed in containing their alcohol con-sumption
within safe limits, and the negative health con-sequences
of excessive alcohol consumption, with which
this report is concerned, are serious and widespread.